What is the recommended dose of Augmentin (amoxicillin/clavulanate) for a throat infection?

Augmentin Dosing for Throat Infection

For throat infections caused by Group A Streptococcus, the recommended dose of Augmentin (amoxicillin/clavulanate) is 40 mg/kg/day of the amoxicillin component divided into three doses for children, or 500 mg twice daily for adults, for a duration of 10 days. 1

Standard Treatment for Streptococcal Pharyngitis

First-line Options (for patients without penicillin allergy):

• Penicillin V (oral):

  • Children: 250 mg 2-3 times daily
  • Adults: 250 mg 4 times daily or 500 mg twice daily
  • Duration: 10 days
  • Strength of recommendation: Strong, high quality evidence 1

• Amoxicillin (oral):

  • 50 mg/kg once daily (maximum 1,000 mg)
  • Alternative: 25 mg/kg twice daily (maximum 500 mg per dose)
  • Duration: 10 days
  • Strength of recommendation: Strong, high quality evidence 1

When to Use Augmentin (amoxicillin/clavulanate)

Augmentin is not typically recommended as first-line therapy for uncomplicated streptococcal pharyngitis. It is specifically indicated in the following situations:

1. For chronic carriers of Group A Streptococcus:

   • Children: 40 mg/kg/day of amoxicillin component in 3 divided doses
   • Adults: 500 mg twice daily
   • Duration: 10 days
   • Strength of recommendation: Strong, moderate quality evidence 1

2. For recurrent streptococcal pharyngitis:

   • When multiple episodes occur over months/years
   • Same dosing as above
   • Strength of recommendation: B-II 1

Special Considerations

Penicillin Allergy

For patients with penicillin allergy, alternative options include:

• Cephalexin (if no immediate hypersensitivity to penicillin)
• Clindamycin
• Azithromycin
• Clarithromycin 1

Administration Guidance

• Take Augmentin at the start of a meal to minimize gastrointestinal intolerance 2
• Complete the full 10-day course even if symptoms improve earlier to prevent acute rheumatic fever 2

Common Pitfalls to Avoid

1. Using Augmentin as first-line therapy for uncomplicated streptococcal pharyngitis - This is unnecessary and contributes to antimicrobial resistance. Reserve Augmentin for specific indications like chronic carriers or treatment failures.

2. Treating viral pharyngitis with antibiotics - Most sore throats are viral and don't require antibiotics. Confirm streptococcal etiology before prescribing.

3. Inadequate duration of therapy - A full 10-day course is recommended for streptococcal pharyngitis to prevent complications like acute rheumatic fever, even if symptoms resolve earlier 2.

4. Treating asymptomatic carriers - Streptococcus carriers generally do not require antimicrobial therapy as they are unlikely to spread infection and are at minimal risk for complications 1.

5. Inappropriate dosing - Ensure correct weight-based dosing for children and appropriate frequency of administration.

By following these evidence-based recommendations, clinicians can effectively treat streptococcal pharyngitis while minimizing unnecessary antibiotic use and preventing complications.